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Idaho rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.04 / $18.04 / $20.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $18.20 / $21.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $16.54 / $16.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.62 / $20.68 / $29.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $20.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.85 / $19.85 / $20.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $23.16